With an Advance Health Care Directive, you can make “end of life” decisions.  You can choose to die naturally, without life support.  However, if your heart stops beating, emergency medical personnel will resuscitate you, even if you have an Advance Health Care Directive.

Some people who suffer pain or have a terminal illness would rather not be resuscitated.  To allow people to refuse resuscitation, the “comfort care only” law was created in 1994.  It provides a way for others to know quickly if a person does not want to be resuscitated when his breathing or heart stops. It requires wearing a special bracelet or necklace.  When emergency medical personnel see the bracelet, they provide only “comfort care,” without trying to resuscitate.  However, there is a problem with the law.  Even if you are wearing the special bracelet, a person can resuscitate you if his conscience requires it.  You can learn more about this law on the Department of Health’s website at www.hawaii.gov/health.  At that website, do a search for “comfort care.”  You can request forms for the comfort care only document and the special bracelet or necklace (which costs $9.50) by phoning (808) 733-9210.      

On July 16, 2009, House Bill 1379 became law without the Governor’s signature.  This new law is called Physician Orders for Life-Sustaining Treatment (POLST).  These Physician Orders cover tube feeding, like an Advance Health Care Directive, and also cover resuscitation, like a “comfort care only” document.  You can request not to be resuscitated if your heart stops beating.  It also covers “medical interventions.”  You can choose comfort measures only, limited additional interventions, or full treatment.  These are actual doctor’s orders, which both you and your doctor sign.  It is a two-sided form, with information on both the front and back.   These orders must be followed by medical personnel, if they know that you have a POLST form.  Under the “comfort care only” law, medical personnel can resuscitate you against your wishes, and are protected from lawsuits.  Under POLST, if someone knows you have a POLST form and resuscitates you against your wishes, you could probably sue that person.  Therefore, if the emergency medical personnel know about your POLST form, they are more likely to follow your “do not resuscitate” wish than if you have a “comfort care only” document.

However, there is a problem with POLST.  It does not provide for a special bracelet for emergency medical personnel to know that you have a POLST form.  In order to make the POLST form clearly visible, it is usually printed on bright lime-green paper.  It is recommended that you post a copy where it can easily be seen, such as on your refrigerator, bedroom door, or on a bedside table.  If you are in a hospital or nursing home, perhaps it should be posted near your bed. You should tell your relatives and friends that you have such orders, and what your wishes are.   

The POLST form may be downloaded from the Kokua Mau website at www.kokuamau.org.  On the homepage you will see where to click to download the POLST form.  Kokua Mau is an organization concerned about end of life care.  They played a major role in getting the POLST law passed in Hawaii.  They recommend printing out the form on 8 ½” x 11” paper, with the color being Lime No. 102053 from Kaleidoscope at Fisher Hawaii.  A black and white form is legal, and even a copy is acceptable, but the bright lime green color will make it easier for people to notice in an emergency.

If you are serious about not wanting to be resuscitated if your heart stops, I recommend that you get ­both the POLST form and the “comfort care only” document and bracelet or necklace.  Then, if an emergency occurs while you are shopping or at a restaurant, emergency medical personnel will see your bracelet.  Also, keep a copy of the POLST form in your purse or wallet.